Provider forms, resources and references
See the items below to stay up to date with forms, reference guides and other items that are important to your practice.
Helpful resources
- Behavioral Health Crisis Services
- Care Management for At Risk Children (CMARC) Standard Referral Form
- Good Faith Contracting Policy
- Healthy Opportunities Pilot - Standard Plan Value-Based Payment Guide
- PCP Change Form - (English version) (Spanish version)
- Pregnancy Risk Screening Form - (English version) (Spanish version)
- Provider Hardship Payment Policy
- UnitedHealthcare Attention-Deficit/Hyperactivity Disorder (ADHD) Toolkit
North Carolina Covered Procedure Code Lists
Submit a pre-service appeal and/or grievance for a Medicaid Member
North Carolina Medicaid Provider Agreement and Regulatory Appendix
The following contract documents are provided for illustrative purposes only and cannot be printed and signed. Please contact our North Carolina Medicaid contracting team at so_atlantic_phys_contracting@uhc.com for a contract specific to your medical practice.
For chiropractors, physical therapists, occupational therapists , speech therapists and speech language pathologists, please visit Optum WebAssist Physical Health or call 800-873-4575.
For behavioral health contract inquires, please call 877-614-0484.